Transcript Mindfulness-Based Cognitive Therapy a Primer

Mindfulness-Based Cognitive Therapy
a Primer
Dr. Kerri McGuire
Women’s Health Issues
April 26, 2007
Outline
• The Territory of Depression
• Why does depression recur?
• Mindfulness-Based Cognitive Therapy
(MBCT)
• Future Directions
The Territory of Depression
• WHO predicts that by 2010 depression will rank second
to cardiovascular disease in economic and personal
costs.
• Chronic illness, typically with several recurrences
Rates of Depressive Relapse Over 15 Years
Risk Factors For Depressive Relapse
• Number of Past Episodes of Depression
• Family History of Depression
• Significant Losses/Stressors
• Cognitive Reactivity to Sad Moods
Qualities of Relapse-Related States of Mind
Automatic
- Little intentional control of attention
- Avoidant or suppressive
Ruminative and Centered on Self
-Strong identification with thoughts and feelings
-Strongly correlated with the past # of depressions
-Gender differences in rumination correlate with
gender distribution in depression
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Problem-Solving
Effectiveness
Positive Beliefs About Rumination
Rumination Can Be Seen To Be
Emotional Wisdom
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Formerly Depressed
Never Depressed
P<.002; Watkins & Moulds (2005)
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Ruminating in Sad
Mood
Ruminating in Normal
Mood
P<.02; J Pers & Soc Psych (2000)
Qualities of Relapse-Related States of Mind
Content
- “In order to be happy, I must be……”
- “Admitting to your mistakes is a sign of weakness”
- “If others look to me for guidance, it would make me
feel important”
Process
- What does feeling this way say about me?
- Why is this (sadness) happening to me?
- How can I change this (sadness)?
Mindfulness-Based Cognitive Therapy
An Integration of MBSR and Cognitive Therapy
A Blend of Acceptance and Change models
Customized for Depression
Mindfulness-Based Stress Reduction
MBSR
• University of Massachusetts Medical Center,
Stress Reduction Clinic,1979
– Jon Kabat-Zinn, Ph.D., founder
– 8 Week Program
– Participants with a wide range of medical problems, including
chronic pain, anxiety disorders, depression, hypertension, heart
disease and cancer.
– Program outlined in the book “Full Catastrophe Living, Using the
Wisdom of Your Body and Mind to Face Stress, Pain and Illness”
A Definition of Mindfulness
Mindfulness means paying attention,
in a particular way,
on purpose,
in the present moment,
and non-judgmentally
Jon Kabat-Zinn
How Does Cognitive Therapy Prevent
Depressive Relapse?
Teaches Patients in Depressed Mood to:
-Switch out of a habitual cognitive mode of mind
-Decenter - thoughts are not necessarily me and
not necessarily true
-Turn towards the Difficult
-Change Degree of Belief
How Does MBCT Prevent Depressive
Relapse?
Teaches Recovered Depressed Patients Regardless of
Mood:
-Automatic to Intentional Mode
-Avoidance to Curiosity & Acceptance
-‘Thinking About’ to ‘Directly Experiencing’
-Judging & Fixing to Non-Doing & Being
The Nature of the Work in MBCT
• Systematic Training to Become More Aware
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–
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Moment to Moment
Bodily Sensations
Pleasant & Unpleasant Events
Thoughts & Feelings as Mental Events
• Formal Practice
– Body Scan
– Mindful Stretching/Yoga
– Mindfulness of Breath/Body/Sounds & Thoughts
The Nature of the Work in MBCT
• Opportunity to Be Mindful Using Activities
– Investigating Pleasure & Mastery
– Taking Skillful Action – Preparing for Relapse
– Inquiry/Discussion of Symptoms & Experiences of Depression
• Informal Practice
– 3 Minute Breathing Space
– Mindfulness of Everyday Activities
3 Minute Breathing Space
Provides a way to step out of automatic pilot mode
and reconnect with the present moment
• AWARENESS
• Acknowledge & register your experience, even if it is
unwanted
•
GATHERING
• Bring full attention to the breath, as an anchor
to awareness & stillness
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EXPANDING
• Awareness of the body as a whole, your posture
and facial expression
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90
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60
MBCT 66%
TAU 34%
1 Year Follow Up
P<.005; J Consult Clin Psych (2000)
60
weeks
50
weeks
40
weeks
30
weeks
20
weeks
50
40
30
20
10
0
10
weeks
% Relapse Free
Rates of Depressive Relapse for Patients
with 3 or More Past Episodes
TAU
MBCT
Single Site Replication
% Relapse Free
1 Year Follow Up
100
90
80
70
60
50
40
30
20
10
0
TAU 22%
MBCT 64%
TAU
MBCT
3+Previous MDD
P<.05; J Consult Clin Psych (2004)
Meditation and the Brain
• Frontal - Limbic pathways
• Numerous studies ongoing
• Meditators versus non-meditators
PET Scans and Meditation
Dorsal Lateral Prefrontal Cortex
Left associated with feelings of happiness & well-being and
approach behaviours
Right associated with feelings of distress and avoidance
behaviours
Meditation
Increased left sided anterior activation compared to controls
Over 8 weeks participants began to shift in the same direction as
Buddhist monks
Future Directions and Research
• Pilot Studies:
– Anxiety disorders including panic disorder
without agoraphobia
– Actively depressed
– Co-occurring addictive and mood
disorders
– Binge eating disorder
– Immune response to Influenza vaccine
Summary
• MBCT was designed to reduce relapse by helping
patients disengage from ruminative thinking triggered by
sad moods.
• MBCT helps patients shift their relationship to thoughts/
sensations/feelings without trying to change belief in
thought content.
• It is ideal for patients in recovery because depression
need not be present for them to practice
• Shown to reduce relapse rate by 50% in patients with
recurrent depression.
Resources
• Books:
– Full Catastrophe Living, by Jon Kabat-Zinn
– Heal Thyself; Mindfulness in Medicine, by Saki Santorelli
– Mindfulness-Based Cognitive Therapy for Depression, by Z.
Segal, J. Williams & J. Teasdale
– Wherever You Go There You Are, by Jon Kabat-Zinn
Web Sites:
www.ottawamindfulnessclinic.com
www.umassmed.edu
Dr. Kerri McGuire: [email protected]